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What narrative... that COVID-19 is most deadly for those over 60? That's literally the only fact that most people know about it. If you think that has been abse

What narrative... that COVID-19 is most deadly for those over 60? That's literally the only fact that most people know about it. If you think that has been absent in all the coverage, I have no idea what coverage you have been paying attention to.

taeric 6y ago
It is and it isn't. This thread is predicated on an IFR that is a flat 5 or so percent on the population. We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus. Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations. (Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
- philwelch 6y ago
  This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages. There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
  - taeric 6y ago
    That was reported as full on no shut down. Just crap reporting? Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population. Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
    - philwelch 6y ago
      Sorry about the edit. The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.) Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions. What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions. Over time you could even allow travel between green zones.
      - taeric 6y ago
        No worries on the edit. Meant that more to explain if I seemed to ignore party of your post. I think you could have gotten pretty good volunteer isolation. As simple as getting grocery stores to deliver to elderly. As expensive as renting the Ritz for a month. Still expensive, but cheap compared to what we have landed in.
    - nl 6y ago
      In Australia we basically did both: shutdown everything, and shutdown all access to nursing homes. It has been disastrous (comparatively). We had a couple of asymptomatic carriers infect some aged care facilities and now nearly 20% of the deaths country wide are from those incidents. And that's with the second best testing regime in the world though March/April (after South Korea). We'd have been better closing the aged care faculties and moving people in with relatives. That's not very practical, but the COVID deaths would almost certainly have been less.
  - user5994461 6y ago
    >>> They scrapped that plan after they updated the model to account for ventilator shortages. Then the use of ventilators was shown to be ineffective, so they can re update the models and bring back the original plan. (See recent articles. In summary none of the patients who are put on ventilators survive.)
    - mschuster91 6y ago
      > In summary none of the patients who are put on ventilators survive Biggest problem: determining if someone dies because or despite of ventilators.
    - JshWright 6y ago
      > In summary none of the patients who are put on ventilators survive. That's simply not true. A very high percentage of them die (because you only put very sick people on ventilators), but to suggest that they all die is just absurd.
      - djsumdog 6y ago
        It's over 88%. For the younger patients it's practically a coin toss: https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows#1 https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
        JshWright 6y ago
        88% is not 100%...
        Gibbon1 6y ago
        Last I saw from UCSF they said the 88% statistic didn't include people still hospitalized. So kinda bogus.
- JshWright 6y ago
  There are millions of people in high risk groups outside of nursing homes. How do you propose protecting them? There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for? The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
  - taeric 6y ago
    We haven't dodged that bullet in our current strategy. And the more data we get, the more it looks like we haven't protected them, honestly. I'll note some of the first cases in WA included a high school student that had not been traveling. I cannot square that, how contagious this is, and the idea that it wasn't widely in that school. I think herd immunity is silly at the holistic level. At a cohort level, though, it could work reasonable. Consider, at this point we could start rotations of health workers that have the antibodies. I have said it before, but I will stress again I am just a random internet poster. Much of why I am posting this is to get challenged on it.
- redis_mlc 6y ago
  > We are locking down everyone to try and kill the virus. What are you talking about? That was never the goal in the US.
  - taeric 6y ago
    That sentence is a shortened version of what we seem to be doing. Which is keep it under control while we race to a vaccine. To kill it. Of course, the more data we get, the less control we see that it was ever in. Such that right now,I don't think we have a coherent plan.
    - JshWright 6y ago
      New York seems to have a reasonable plan. Hospitalization rate is under control, careful planning is going into how to reopen the state in a tiered way, etc.
      - taeric 6y ago
        What are they doing to keep it out of the rest of their long term care facilities? Note that they have over a million people over sixty. And if you redo their numbers assuming the CFR is roughly known in the different age brackets, things could get much much worse. (That is, the CFR in WA is in very low numbers holistically. For the sixty plus? It is over 15%!!) So, unless they have something protecting them, just reopening slowly didn't really have a mechanism to protect them. Now, they could go for herd immunity in care workers. Rotate in those with antibodies, and you are simulations how we protect the elderly from the flu. But just slowly reopening? What is the mechanism that is expecting a change?
        JshWright 6y ago
        It's not just "slowly reopening". The reopening is predicated on testing capacity, as well as the ability to adequately track and trace.
        6y ago

taeric 6y ago

It is and it isn't. This thread is predicated on an IFR that is a flat 5 or so percent on the population. We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus. Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations. (Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)

philwelch 6y ago
This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages. There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
- taeric 6y ago
  That was reported as full on no shut down. Just crap reporting? Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population. Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
  - philwelch 6y ago
    Sorry about the edit. The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.) Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions. What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions. Over time you could even allow travel between green zones.
    - taeric 6y ago
      No worries on the edit. Meant that more to explain if I seemed to ignore party of your post. I think you could have gotten pretty good volunteer isolation. As simple as getting grocery stores to deliver to elderly. As expensive as renting the Ritz for a month. Still expensive, but cheap compared to what we have landed in.
  - nl 6y ago
    In Australia we basically did both: shutdown everything, and shutdown all access to nursing homes. It has been disastrous (comparatively). We had a couple of asymptomatic carriers infect some aged care facilities and now nearly 20% of the deaths country wide are from those incidents. And that's with the second best testing regime in the world though March/April (after South Korea). We'd have been better closing the aged care faculties and moving people in with relatives. That's not very practical, but the COVID deaths would almost certainly have been less.
- user5994461 6y ago
  >>> They scrapped that plan after they updated the model to account for ventilator shortages. Then the use of ventilators was shown to be ineffective, so they can re update the models and bring back the original plan. (See recent articles. In summary none of the patients who are put on ventilators survive.)
  - mschuster91 6y ago
    > In summary none of the patients who are put on ventilators survive Biggest problem: determining if someone dies because or despite of ventilators.
  - JshWright 6y ago
    > In summary none of the patients who are put on ventilators survive. That's simply not true. A very high percentage of them die (because you only put very sick people on ventilators), but to suggest that they all die is just absurd.
    - djsumdog 6y ago
      It's over 88%. For the younger patients it's practically a coin toss: https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows#1 https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
      - JshWright 6y ago
        88% is not 100%...
        Gibbon1 6y ago
        Last I saw from UCSF they said the 88% statistic didn't include people still hospitalized. So kinda bogus.
JshWright 6y ago
There are millions of people in high risk groups outside of nursing homes. How do you propose protecting them? There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for? The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
- taeric 6y ago
  We haven't dodged that bullet in our current strategy. And the more data we get, the more it looks like we haven't protected them, honestly. I'll note some of the first cases in WA included a high school student that had not been traveling. I cannot square that, how contagious this is, and the idea that it wasn't widely in that school. I think herd immunity is silly at the holistic level. At a cohort level, though, it could work reasonable. Consider, at this point we could start rotations of health workers that have the antibodies. I have said it before, but I will stress again I am just a random internet poster. Much of why I am posting this is to get challenged on it.
redis_mlc 6y ago
> We are locking down everyone to try and kill the virus. What are you talking about? That was never the goal in the US.
- taeric 6y ago
  That sentence is a shortened version of what we seem to be doing. Which is keep it under control while we race to a vaccine. To kill it. Of course, the more data we get, the less control we see that it was ever in. Such that right now,I don't think we have a coherent plan.
  - JshWright 6y ago
    New York seems to have a reasonable plan. Hospitalization rate is under control, careful planning is going into how to reopen the state in a tiered way, etc.
    - taeric 6y ago
      What are they doing to keep it out of the rest of their long term care facilities? Note that they have over a million people over sixty. And if you redo their numbers assuming the CFR is roughly known in the different age brackets, things could get much much worse. (That is, the CFR in WA is in very low numbers holistically. For the sixty plus? It is over 15%!!) So, unless they have something protecting them, just reopening slowly didn't really have a mechanism to protect them. Now, they could go for herd immunity in care workers. Rotate in those with antibodies, and you are simulations how we protect the elderly from the flu. But just slowly reopening? What is the mechanism that is expecting a change?
      - JshWright 6y ago
        It's not just "slowly reopening". The reopening is predicated on testing capacity, as well as the ability to adequately track and trace.
        6y ago